Pediatric Critical Care Training and Experience

Clinical Training

During clinical service months in the PICU, fellows are expected to provide hands-on patient care, as well as supervise and direct patient care provided by residents. By the end of the first year of training, the fellow will have gained experience in the recognition, triage, and management of a wide variety of acute illnesses, and will have gained skill in the performance of invasive procedures. Though the second and third years are skewed toward research time, four months per year will be dedicated to the honing of clinical skills with emphasis on plan-making and team leadership.

Fellows will provide overnight ICU coverage during the Anesthesia and Sedation Service rotations. Coverage responsibilities will not exceed an average of every fourth night during these rotations.

Five other clinical rotations serve to round out the PCCM fellow’s clinical education:

1. Fellows will participate in the Sedation service for one month each during the first two years of training. This service, run through the Division of Critical Care Medicine, provides conscious and deep sedation for painful procedures and diagnostic imaging throughout the hospital. Fellows will develop expertise in pre-sedation screening, the use of an array of sedative and analgesic medications, patient monitoring, and airway management techniques. All of this will take place under direct attending supervision. While on this rotation, fellows will take overnight call in the PICU.
2. Early in the first year one month is spent on the Anesthesia service gaining experience with airway management and vascular access in the operating room.
3. One month per year will be spent on the Cardiothoracic ICU service including providing every fourth-night, in-house call in the CTICU.
4. In the second year, one month is spent on the Pediatric Surgical Service. While on this rotation, the fellow will gain experience in the triage and management of acute trauma including thermal injuries. While taking in-house call, the PICU fellow will serve as a member of the trauma team, supervised by upper level surgical trainees and attending staff.
5. In the third year, one month will be spent on the Transplant service at The Ohio State University Medical Center.

Cardiothoracic Intensive Care: The Cardiothoracic ICU rotation is designed to allow the fellow to have a focused experience in the management of critically-ill medical and surgical cardiac patients and thoracic surgery patients including children with lung transplantation. The fellow will work closely with one of our cardiac intensivists and participate in pre- and post-surgical management of congenital heart disease, be present in the operating room during surgical correction, and attend focused didactic sessions offered by the Division of Cardiology. In-house call consists of coverage of ONLY the children in the cardiothoracic intensive care area.

The Ohio State University Medical Center: While bone marrow, heart, lung, heart/lung and kidney transplants are performed at Nationwide Children's Hospital, the Transplant service at OSU offers a strong experience in the management of a larger and more diverse abdominal solid organ transplant patient population. Fellows will round with the transplant service and participate in didactic sessions which together will ensure an understanding of the fundamentals of peri- transplant medicine. This rotation will be call free.

Research Education

The cornerstone of the PCCM fellows’ research experience is The Research Institute at Nationwide Children's Hospital. Please see the The Research Institute website for more detailed information, but briefy:

• The Research Institute is a separately incorporated subsidiary of Nationwide Children's Hospital whose mission is to support biomedical and behavioral research on the Nationwide Children's Hospital campus.
• Administratively, The Research Institute is divided into Centers including Biobehavioral Health, Cardiovascular and Pulmonary Research, Childhood Cancer, Gene Therapy, Injury Research and Policy, Innovation in Pediatric Practice, Microbial Pathogenesis, Molecular and Human Genetics, Perinatal Research, Quantitative and Computational Biology and Vaccines and Immunity. Each of these Centers encompasses research topics which are relevant to Pediatric Critical Care Medicine.
• The Research Institute also has core facilities which offer the following state-of-the-art services to researchers: Biostatistics, DNA Sequencing, Functional Genomics, High Throughput Genotyping and Sequencing, Morphology, Clinical Research Services, Transgenic and Embryonic Stem Cell, and Viral Vector.
• The Research Institute boasts over 130 Principal Investigators and 900 employees; received $69.4 million in external funding in 2010; and occupies 225,000 square feet of research space. Additional research space is expected to be completed in 2012. Research faculty members also hold faculty appointments at The Ohio State University. Should a fellow’s area of interest lie outside the scope of The Research Institute, resources of the general university academic community can be made available.

In order to integrate the PCCM Division and The Research Institute into the subspecialty residents’ research training program, a PCCM Scholarship Oversight Committee has been created. It consists of Kelly Kelleher MD, MPH (Director of the Center for Innovation in Pediatric Practice) and Mark Hall, MD. Dr. Kelleher is in an ideal position to direct young investigators toward productive experiences in basic and clinical research. Dr. Hall provides a bridge between the PCCM Division and The Research Institute which insures a research experience which will be relevant to Pediatric Critical Care Medicine.

Members of the PCCM Scholarship Oversight Committee will assume the following responsibilities:

• First year trainees will receive an orientation to The Research Institute and The Ohio State University academic communities including tours of relevant facilities and an overview of the ongoing research in each Center.
• Trainees will each formally meet with the Committee every 6 months with the following goals:
  • First year: Selection of an area of interest; matching with an appropriate mentor; development of a hypothesis and research plan.
  • Second year: Research plan implementation with collection of data and preliminary data analyses; presentation of early findings at appropriate local and national meetings.
  • Third year: Completion of data collection and analyses; preparation of manuscript(s) for publication; presentation of findings at appropriate local and national meetings.
• While individual mentors will be responsible for day-to-day oversight of the trainees’ research development, including instruction in relevant research techniques, Committee members will be available throughout the training program for consultation and will be responsive to problems with individual trainees or mentors. We are committed to providing a supportive research environment for our trainees.

We expect the Pediatric Critical Care Medicine subspecialty trainees to become fully integrated into the research program of their chosen mentor and will have appropriate resources made available to them. Trainees will not be responsible for securing their own research funding. Competitive intramural seed grant funding is available, however, for trainees who wish to augment their research projects and gain experience with the grant writing process.

Didactic Education

Twice-weekly acute care management seminars give way in the early part of the year to a series of weekly seminars on a broad array of topics with relevance to pediatric critical care medicine, given by experts in each field. Fellows are expected to organize and present at our twice-monthly journal club and monthly morbidity and mortality conferences. In addition, core competency lecture series are presented at Nationwide Children's Hospital and The Research Institute.